Over the last eighteen months, our NHS homeopathy campaign has sought to identify and challenge NHS spending on homeopathic remedies. With limited resources available to the NHS, we feel it’s crucially important that patients have access to the best treatments, which means ensuring money is not wasted on treatments that are neither effective nor cost-effective. Given that the NHS’s own website confirms that homeopathy is not effective, and the government’s Science and Technology Select Committee evaluated the evidence in favour of homeopathy and recommended a cease to all NHS spending on the pseudoscientific nostrum, we believe it is unjustifiable for any part of the NHS to spend public funds on these thoroughly-discredited sugar pills.
Fortunately, our campaign has seen some success, with our legal challenge resulting in NHS Liverpool CCG revisiting their decision to fund homeopathy, and with our correspondence with other NHS bodies around the country revealing that many are either reviewing or ending their homeopathy spending. This is clearly a positive trend, not just as milestones in the movement of the NHS away from pseudoscience, but also in real-world terms: every penny not frittered away on ineffective sugar pills is money which can be allocated to healthcare interventions which genuinely work. With the ineffectiveness of homeopathy beyond doubt, any steps we can take to lessen the waste of funds on homeopathic remedies can only be of benefit to the NHS, and to NHS patients.
Of course, homeopathy is not the only potential source of wastage on the NHS, and it is clearly important that other unjustifiable spends are identified and limited. One area which could be prone to inefficiency is in prescriptions: with so many drugs available, how can the NHS ensure the most cost-effective drugs are used? And how can the NHS prevent the prescribing of remedies which are not able to offer benefit to the patient?
The answer to these questions lies in part in Schedule 1 of the National Health Service (General Medical Services Contracts) (Prescription of Drugs etc.) Regulations 2004. Schedule 1 is more commonly referred to as the ‘Blacklist’, and as the name suggests it is used to restrict the prescribing of remedies and drugs which are not deemed to be cost-effective or are not deemed to be beneficial to patients. The list currently contains over 3000 items, including acne lotions, Nurofen, cough syrups, vitamin pills, suntan lotion, spice cake, wine and Ribena. Put simply, if something appears on the Blacklist, GPs cannot prescribe it.
The reasons why something may qualify to be added to the black list are various. It might be that a drug is added because it offers no advantage over other drugs – this may become particularly relevant when a drug is out of patent, and so the generic brand is as effective as the patented brand, but much cheaper. In these cases, it is a sensible decision to restrict prescribers to use only the generic brand, adding the branded drug to the list.
A product may also be added to the blacklist if it is deemed to have no medicinal or therapeutic value. This is presumably the primary reason we see entrants such as ‘spice cake’ and ‘wine’, although the mind boggles somewhat at the consultation process where their addition was deemed to be highly important.
The final consideration for addition to the blacklist is, inevitably, cost: If the cost of the product cannot be justified, the product is prohibited from prescription. There are a number of reasons why this is sensible, for instance where a product is cheaply available over the counter to the public. If a member of the public can buy packs of unbranded ibuprofen at their local supermarket for under a pound, it stands to reason that branded ibuprofen ought not to be available on prescription. Equally, if a product is not considered a priority for the use of limited NHS resources, it is prohibited from prescription – which explains the presence of items such as suntan lotions on the list. As important as suncream is, it would be hard to argue it is an urgent priority for the NHS, especially when it is so readily available over the counter.
Those, then, are the criteria for adding products to the Blacklist – and it should be clearly apparent at this point that by every standard, homeopathic remedies ought to be added to the list. Given that there is no medicinal or therapeutic value to remedies that have been shown to be ineffective, it would be impossible to argue that they are a better alternative to an existing treatment. What’s more, arguments around cost-effectiveness are fatally undermined when the product has no effectiveness, thus quite clearly any funds spent on homeopathy must constitute an unjustifiable cost. Homeopathic remedies are available relatively cheaply in high street stores around the country, so even setting aside their ineffectiveness, there are more efficient ways for the public to obtain their remedies. It’s clear that homeopathy is not a priority for the use of the limited resources available to the NHS.
In January of this year, we made precisely this argument to the Secretary of State for the Department of Health, arguing that not only should homeopathy be added to the Blacklist, but that a failure to do so would be unfairly prejudicing against some of the 3000-plus products already listed, some of which have a far greater grounding in evidence of efficacy than homeopathy. Given that Mr Hunt MP had himself said in September 2014 that “when resources are tight we have to follow the scientific evidence and spend the NHS’s money on what works and what the scientific evidence says works”, we sincerely hoped he would take up our invitation and consider adding homeopathy to the list.
The initial response from the Department of Health was not encouraging, stating that there were no plans to add to the Blacklist, nor had any additions been made for some time. This, unfortunately, appeared to be in conflict with the duties of the Secretary of State to ensure transparent decision making as to what GPs can and cannot prescribe – something we were able to remind the department of in our follow-up correspondence. We explained that a laissez-faire approach not only failed to meet the standards set by the European Commission, but also unfairly discriminated against the products which had already been listed.
After a further series of correspondence through March and April, in June we submitted a pre-action letter to the Department of Health notifying them of our intention to challenge their Blacklisting decision with a Judicial Review. We felt our case was strong: in our estimation, the Secretary of State had failed to take into account the arguments we raised and had failed to reassure us that products on the Blacklist were there due to a consistently-applied set of criteria.
In mid-September we called off our legal challenge: while the Department of Health didn’t agree to homeopathic remedies to the schedule 1 “Blacklist” immediately, they did inform us that the move was being considered as part of an overall post-election review of NHS funding decisions, stating: “these discussions relate to products currently available under pharmaceutical remuneration, which by definition, includes homeopathic products.”
A comprehensive review of products which can be prescribed and reimbursed by the NHS is certainly an interesting development, and we keenly await the outcomes, particularly with respect to homeopathic remedies. We firmly believe that any spending of limited NHS resources on homeopathy is unjustifiable, and we are prepared to continue our campaign of legal challenges to highlight the wastage of public money on these firmly-discredited remedies.